Circumcision

Evidence based non-biased article. Please don't debate, these are just the facts and everyone has to decide for their own son.

WHAT IS CIRCUMCISION?

Circumcision is defined as the removal of the foreskin from the glans (head) of the penis.

CULTURAL CONSIDERATIONS

Followers of the Jewish and Muslim faiths often perform circumcision for religious reasons. In English speaking countries circumcision became popular beginning in the 1930â€™s.

In the US, circumcision rates vary by region, with the fewest boys circumcised in the West and the most in the Midwest. An average of 56% of boys are circumcised in the entire US. Worldwide, 20% of boys are circumcised. In Washington State, between 25-30% of boys are circumcised.

WHAT IS THE PURPOSE OF THE FORESKIN?

The foreskin serves many functions:

* Protects the glans (head of the penis) from urine, feces and mechanical irritation â€“ it keeps the penis safe, warm, clean and moist. The glans itself has no ability to produce lubricating oil and relies on the foreskin to provide lubrication.

* Covers the opening of the urethra (tube that carries urine) and protects against urethral infection. The foreskin directs sterile urine back around the head of the penis to flush out microbes.

* Provides skin for the penis to expand during erection, as well as provide some slack to reduce friction. Without the foreskin, skin is pulled up from the scrotum to accommodate the erection. The foreskin is the equivalent of a postcardâ€™s worth of skin in an adult.

* Made of highly sensitive tissue, with dense concentrations of highly specialized nerve endings, including the ridged band. During erection, the foreskin turns inside out, exposing the inside lining of the foreskin, enhancing pleasure.

* Lined with immune cells that fight infection. These cells produce antimicrobial and antiviral substances (similar to those found in breast milk), along with immunoglobulins.

At birth, the foreskin is still fused to the head of the penis, because the genitals are not fully developed, and the opening of the skin is narrow. With increasing sexual maturity, repeated erections, and self-exploration, the foreskin gradually separates, and the opening widens, so the foreskin is usually able to be retracted by the time the boy reaches puberty. As the foreskin separates, these cells make their way to the opening in the skin, creating white â€œpearlsâ€ that are called infant smegma. Adults produce a type of smegma that acts as a protective, lubricating substance.

WHAT ARE THE PROS OF CIRCUMCISION?

* Risk of urinary tract infection in the first year of life is decreased from 1.4% to 0.14%. Urinary tract infections are treated with antibiotics.

* Eliminates the risk of infection of the foreskin (balanitis).

* Circumcised boys have slightly lower rates of syphilis and gonorrhea, which are sexually transmitted infections. Some African studies have found circumcised men to be at lower risk of contracting HIV, but these results are not thought to translate to the US, where there are different cultural and sexual practices, and better access to condoms and hygiene. There is no known correlation between circumcision and rates of genital warts, urethritis, chlamydia or herpes. Consistent condom use, mutually monogamy and abstinence are the most effective ways to reduce transmission of sexually transmitted infections.

* There are around 1500 total cases of penile cancer per year in the US. Nearly all of them are in uncircumcised men. Being circumcised reduces a manâ€™s chance of having penile cancer by 0.2%. An estimated 322,000 circumcisions would have to be performed to prevent one case of penile cancer. Good hygiene is believed to offer equal protection from this kind of cancer. HPV is thought to be responsible for around 40% of penile cancers. 1

WHAT ARE THE CONS OF CIRCUMCISION?

* Decreased sensation of the penis due to removal of highly sensitive tissue.

* Dryness of the head of the penis (glans) due to removal of the lubricating organ, requiring artificial lubricants. Once the glans is exposed, the skin changes from â€˜insideâ€™ skin to â€˜outsideâ€™ skin, becoming thicker (keratinized).

* Tight circumcisions can restrict the erection or cause skin to be pulled up from the scrotum. This scrotal skin is likely to have hair, which can be irritating to the partner. Penile skin does not usually have hair.

* Complications occur in approximately 0.1-35% of babies undergoing the procedure. The most common complications are infection, bleeding and incomplete circumcision.

* Death is very rare as a result of circumcision, and risk has been estimated to be 1/500,000 procedures.

* Meatitis (infection of the urethra, the tube that carries urine) and scarring of the urethral opening have been reported in 8-21% of circumcised infants.

* Circumcision should not be performed on infants who are not stable, or who have any abnormalities of the reproductive/urinary tract, including hypospadias.

THE PROCEDURE

To prepare the baby for the procedure, he is laid on a table or specialized tray, and his arms and legs restrained so he is unable to squirm during the procedure. The genital area is cleaned with surgical cleanser and dried.

For many decades, physicians insisted that babies did not feel pain. There is clear evidence, however, that they do. Anesthesia is becoming routine during circumcision, though it is not always used. Anesthesia may consist of injected local anesthetic, topical anesthetic, sugar water given by mouth (reduces pain response), or a combination.

CARING FOR THE PENIS

The circumcised penis will be bright red and raw for a few days and will need some special care, involving lubricated dressings to prevent the site from sticking to the diaper or clothes and to prevent infection. After the skin has thickened and the surgical site has healed, only routine bathing will be required.

An uncircumcised (intact) penis requires no special care. Once a boy has retracted his own foreskin, he can be taught to wash his penis and foreskin while bathing. The foreskin should not be forcibly retracted, as infection, adhesions and scarring can occur. Clean the penis with warm water from base to tip, and only clean what can be seen.

POSITION STATEMENTS

American Academy of Family Physicians

The AAFP Commission on Science has reviewed the literature regarding neonatal circumcision. Evidence from the literature is often conflicting or inconclusive. Most parents base their decision whether or not to have their newborn son circumcised on nonmedical preferences (i.e. religious, ethnic, cultural, cosmetic). The American Academy of Family Physicians recommends physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son. www.aafp.org/online/en/home/clinica...

American Academy of Pediatrics

1999 Policy Statement, reaffirmed in 2005: Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy.

2012 Policy Statement: Male circumcision is a common procedure, generally performed during the newborn period in the United States. In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academyâ€™s 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedureâ€™s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement.

In the past, circumcision has been suggested as a way to prevent penile cancer. This was based on studies that reported much lower penile cancer rates among circumcised men than among uncircumcised men. But in many of those studies, the protective effect of circumcision was no longer seen after factors like smegma and phimosis were taken into account.

Most public health researchers believe that the risk of penile cancer is low among uncircumcised men without known risk factors living in the United States. Men who wish to lower their risk of penile cancer can do so by avoiding HPV infection and not smoking. Those who aren't circumcised can also lower their risk of penile cancer by practicing good hygiene. Most experts agree that circumcision should not be recommended solely as a way to prevent penile cancer. www.cancer.org/Cancer/PenileCancer/...

I think this is helpful. I'm very torn on what to do and have been against trying to "Google" because of all the one-sided propaganda that's out there.
Still not sure what to we'll do for our son, but this article is a good start for information. Next step will be to discuss with our dd's pediatrician.

I don't care for putting my 2 cents into a debate where my opinion means nothing to other people... so, I'll just say thanks for at least giving me a good starting place to get as unbiased info on the topic as is possible anymore on the internet

I think this is helpful. I'm very torn on what to do and have been agains...

Posted
12/22/2015

I think this is helpful. I'm very torn on what to do and have been against trying to "Google" because of all the one-sided propaganda that's out there.
Still not sure what to we'll do for our son, but this article is a good start for information. Next step will be to discuss with our dd's pediatrician.
I don't care for putting my 2 cents into a debate where my opinion means nothing to other people... so, I'll just say thanks for at least giving me a good starting place to get as unbiased info on the topic as is possible anymore on the internet

I enjoyed the article. It was very well written and gave both sides of circumcised and uncircumcised penis. I will respect you since you asked for no debate. There really isn't anything in there that can be debated apon. It didn't tell anyone to do anything. It just gave facts. So anyone who argues this post is doing it because they either have a very strong opinion on a circumcised/uncircumcised penis or they love to argue for the sake of aruging.

Thank you for the information. My DH (dear husband) was very strong on his kids being circumcised so I never really went out and researched the procedure and it's pros and cons. I'll be asking next time at my l&d what they do when they take him back to get cut. My first lo seemed fine when he came back from being cut so I didn't think about if it hurt him or not. My husband's assurances of it not being painful took that question away from my mind.

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